Graham Dinsdale1, Chris Roberts2, Tonia Moore3, Joanne Manning3, Michael Berks4, John Allen5, Marina E Anderson6, Maurizio Cutolo7, Roger Hesselstrand8, Kevin Howell9, Carmen Pizzorni7, Vanessa Smith10, Alberto Sulli7, Marie Wildt8, Christopher Taylor4, Andrea Murray1, Ariane L Herrick1,11. 1. Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. 2. Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK. 3. Rheumatology Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK. 4. Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK. 5. Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne, UK. 6. Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK. 7. Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy. 8. Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden. 9. Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK. 10. Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium. 11. NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Abstract
Objectives: Nailfold capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state. Methods: A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers. Results: For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%. Conclusion: During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces capillaroscopy sensitivity.
Objectives: Nailfold capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state. Methods: A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers. Results: For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%. Conclusion: During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces capillaroscopy sensitivity.
Authors: Michael Berks; Graham Dinsdale; Elizabeth Marjanovic; Andrea Murray; Chris Taylor; Ariane L Herrick Journal: Rheumatology (Oxford) Date: 2021-08-02 Impact factor: 7.580
Authors: Dina M Abd El-Khalik; Eman A Hafez; Hanan E Hassan; Asmaa E Mahmoud; Doaa Maamoun Ashour; Nashwa A Morshedy Journal: Clin Med Insights Endocrinol Diabetes Date: 2022-09-15